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From Flashcardlet > Peds-GI Bleeds > Flashcards

Peds-GI Bleeds Flashcards

1
Q

Hematemesis

A

implies recent or ongoing hemorrhage proximal to ligament of Treitz

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2
Q

Hematochezia

A

describes bright red/maroon colored stool; suggests bleeding from colon

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3
Q

Melena

A

black, tarry stool assoc. w/ bleeding proximal to ileocecal valve

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4
Q

Signs of decreased vascular volume

A

tachycardia
postural hypotension
pallor
prolonged capillary refill time

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5
Q

GI bleed- ascertain blood (red)

A 
commercial dyes
ampicillin
beets 
laxatives
phenytoin
rifampin
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6
Q

GI bleed- ascertain blood (black/ dark)

A 
spinich
blueberries
licorice
dirt
dark chocolate
bismuth
iron
lead
activated charcoal
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7
Q

Stool guaiac

A

leukodye that uses peroxidase-like activity found in Hgb
confirms presence of Hgb in stool
false+ if other substance w/ peroxidse-like activity
false neg- consumption of Vit C

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8
Q

GI bleed guaiac false positive

A 
ferrous sulfate
meat
horseradish
turnips
bean sprouts
broccoli
cauliflower
tomatoes
fresh, red cherries
grapes
cantaloupes
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9
Q

GI bleed guaiac false negative

A

vitamin C
Hgb degradation
storage specimens
>4 days

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10
Q

Causes of upper GI bleed in infant

A 
swallowed maternal blood
   postpartum
   breast source
reflux esophagitis
gastric ulcer
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11
Q

Causes of upper GI bleed in older child

A 
epistaxis
Mallory-Weiss tear
gastritis
peptic ulcer
duodenitis
tonsillitis/ sinusitis
medications
esophageal varices
coagulopathy
tumors
pulmonary hemorrhage
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12
Q

Causes of lower GI bleed in newborn

A 
swallowed maternal blood
allergic colitis
Hirschsprung's dz (BIG descending colon)
coagulopathy/ vitamin K deficiency
malrotation w/ midgut volvulus
necrotizing enterocolitis
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13
Q

Causes of lower GI bleed in infants

A 
anal fissures
infectious colitis
allergic colitis/ milk protein intolerance
swallowed maternal blood
malrotation w/ midgut volvulus
Hirschsprung's Dz
intestinal duplication
lymphonodular hyperplasia
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14
Q

Causes of lower GI bleed in preschool children

A 
infectious colitis
Henoch-Schonlein purpura
meckel's diverticulum
juvenile polyp
hemolytic-uremic syndrome
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15
Q

Causes of lower GI bleed in school age children

A 
infectious colitis
Henoch-Schoenlein purpura
Infalmmatory bowel dz
Meckel's diverticulum
juvenile polyp
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16
Q

Uncommon lower bleed causes in infant

A

vascular lesions
Hirschsprung’s dz
intestinal duplication

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17
Q

Uncommon lower bleed causes in older child

A 
vascular malformations 
intestinal duplication
hemorrhoids
rectal trauma (abuse)
juvenile polyp
CMV colitis
amebiasis
18
Q

Swallowed maternal blood

A

common

trauma to mother’s nipple & areola

19
Q

Acute gastroenteritis

A 
acute inflammation of GIT usually d/t infectious origin
very common
wide spectrum of presentation
   anorexia
   n/v
   diarrhea
   fever
20
Q

Assessment of risk for acute gastroenteritis

A 
age < 18 mo
poor SES
malnutrition
immunodeficiency
underlying dz (congenital heart dz)
poor capability of caregiver to provide care & observation
21
Q

Viral causes of acute gastroenteritis

A

rotaviruses
Norwalk virus
enteroviruses

22
Q

Sx’s of acute viral gastroenteritis

A

vomiting
diarrhea
poor hydration
mild fever

23
Q

Some agents used to tx viral gastroenteritis

A 
antimicrobials
antidiarrheal (no anti-motility in infants & young children)
antiemetics
zinc
lactobacillus supplements
24
Q

Clinical features of allergic colitis

A 
healthy-appearing infants
fussiness
increased frequency of BM
blood-tinged stools
age 1 wk to several months (avg. 60 days)
25
Q

Dx allergic colitis

A 
sx's
withdrawal of allergen
re-challenge
bx (colonoscopy)
   patchy erythema
   loss of vascularity
   eosinophilic abscesses
26
Q

Mgnt of allergic colitis

A 
cow's milk protein eliminated from diet
replace w/ protein hydrolysate formula
   Nutramigen
   Alimentum
Most infants do well with re-introduction of cow's milk protein after 4-5 months
27
Q

Meckel’s Diverticulum

A

ileal mucosal bleeding caused by heterotopic gastric mucosa (incomplete closure of omphalomesenteric duct)
acid prod. leads to ulceration
painless bleeding
anemia (may be profound/ occult) w/o
many symptoms
May be assoc. w/ intussusception/ perforation

28
Q

Dx & Tx Meckel’s diverticulum

A

technetium “Meckel’s” scan
tagged red cell scan (useful in rapid bleeding)

tx- surgical excision, medical (acid reduction agents, tx anemia with Fe, EPO, transfusion)

29
Q

Hemolytic Uremic Syndrome

A 
Acute gastroenteritis
   E. coli 0157:H7
   shiga-like toxin
   intravascular coagulopathy leading to 
   hemolysis
   hemolysis leading to ARF
   coagulopathy also tends to lower 
   platelets
30
Q

Henoch-Schonlein pupura

A 
Clinical:
   nephritis
   abdominal pain
   purpura
   arthralgias
Complications of vasculitis:
   abdominal pain
   intussusception
31
Q

Anal fissure

A 
MCC of lower GI bleeding
most cases 2ndary to constipation
DDx:
   constipation, child abuse, trauma, crypt 
   abscess
32
Q

Intestinal duplication cyst

A

congenital intestinal malformation sharing a wall with the normal intestine & lined with enteric mucosa
may present as mass/ painless bleed

33
Q

Lymphonodular hyperplasia

A

self-limited condition, possibly related to food allergies

Dx on colonoscopy

34
Q

Biliary atresia (extrahepatic)

A

direct hyperbilirubinemia in 1st 2wks of life
will progress to liver failure if not caught in 1st 3-4 mon
tx with Kasai procedure (appendix used as common bile duct)

35
Q

Alagille syndrome

A

paucity of bile ducts (intrahepatic)
lifelong jaundice & pruritis
typically does NOT progress to liver failure

36
Q

Neonatal hepatitis

A

ill-appearing w/ jaundice w/ liver enlargement

CMV & syphilis must be r/o

37
Q

alpha1-antitrypsin deficiency

A

cholestatsis & hepatomegaly in 20%

requires liver transplant

38
Q

Serum sickness (Hep B may resemble)

A

migrating polyarticular arthritis
urticaria
maculopapular rash
glomerulonephritis

38
Q

Direct (conjugated) hyperbilirubinemis is always…

A

ABNORMAL

39
Q

Fulminant liver failure

A

inborn errors of metabolism & bile acid synthesis

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